|Preputial irritation, 1898|
The irritable prepuce and its cure
J.H Beaty MD explains how nervous and other diseases in boys – anything from epilepsy and asthma to nose-picking and masturbation – are often caused by an over-sensitive or irritable foreskin, and can thus be alleviated by detaching the foreskin from the glans, and permanently cured by circumcision.
Some common peripheral irritations in boysIn preparing this paper on this, so vital a subject, I have done very little theorizing, but beg to present reports and comments on a few representative cases.
Case 1: Boy aged six years. Fell into an epileptiform fit. No history of any trouble and no other apparent cause than preputial irritation.
Examination showed prepuce long and contracted with orifice hardly large enough to admit a small probe. Under chloroform operated and found adhesions over whole glans and much smegma lodged behind corona. Made full circumcision and broke up all adhesions. Result: no more fits after a year.
Case 2: Shows at what an early age a child with local irritation may acquire the habit of masturbation.
Boy aged six. Had been detected by his kindergarten teacher acting strangely. After some suspicious movements a strange look would come over his face, after which he would become limp, pale and languid for some time. A close watch was kept, and it was found that he was not only himself masturbating, but had taught his four-year-old brother the art; and these strange looks and actions were evidently connected with a distinct sexual orgasm.
Examination showed prepuce normal in length but adherent over the whole top of the glans. To combine mental with physical reformation, these adhesions were broken without an anaesthetic (a very painful procedure both to the patient and everyone else within a block); for a while he was better, but after some weeks was detected in his old habit, and it was found that the prepuce was again adherent. Again the work was done, eliciting loud assurances that he would be good, and as far as I was ever able to learn he kept his promise.
Case 3: Boy, aged three and one-half years, was noticed to pick the nose and show other so called “worm symptoms”, also was noticed to stagger and fall often and preferred to play sitting or lying down. Found prepuce redundant, contracted and adherent. Circumcised and broke adhesions. Result, complete cure of all the unpleasant symptoms.
Case 4: Boy aged two and one-half years. Flabby, ill-nourished, peevish and sickly. Found usual contracted and adherent prepuce, also inguinal hernia. Applied truss but found it hard to retain the hernia, and got no improvement in general health, although I prescribed carefully.
Attended to the lesions of the penis, and improvement began almost immediately, and now after a year and a half the child is strong and well, the hernia seldom comes down, and we hope to be able to lay aside the truss in the course of time.
Case 5: Boy, aged twelve, has suffered from asthma for several years and is getting worse. Prescribed carefully for a month with no improvement. He was taken to an allopath, who prescribed with the same result. Upon a more thorough examination, no trouble was found anywhere, except a very slight adhesion of the prepuce not more than a quarter of an inch wide. Without any expectation of a good result I broke this adhesion and advised a change of climate, but to the surprise of us all improvement was immediate and rapid, and although no more medicine was given, the boy is now, after six months, perfectly well.
Case 6: Is a strange case of over-development of the sexual organs. Boy, aged eight years, rather small for his age, poorly nourished and very nervous.
Two years before I saw him he had been victimized by a neighbour girl slightly older than himself, and undoubtedly had been made acquainted with sensations far in advance of his years, but I could get no evidence of masturbation, even after having him closely watched for several months. At the time of examination the penis was very irritable, erecting at the slightest touch and presenting every appearance of a fully developed organ in the state of very strong erection and large enough for an average boy of fourteen years.
Under chloroform the organ relaxed and showed the prepuce to be quite redundant. I circumcised, slitting the foreskin well back to make it loose, and cut the frenum. The result was marked and immediate, the peculiar nervous wiggle left him at once, and the boy has since gained rapidly in general nutrition, and is growing rapidly.
I find in my case-books a number of cases of enuresis [i.e. bed-wetting] cured by relieving preputial irritation, and can say that I never yet have seen a boy who suffered from this most troublesome symptom who had not some local irritation, and so far I have cured every case.
Another malformation and source of irritation usually overlooked is the short frenum. I find this a very common accompaniment, if not a cause, of involuntary emissions, and I have found as a result of cutting the frenum in six cases of this trouble that cure has followed in three cases, one has not reported and two are improved.
In my methods of operating I have no set rule, but try to give each case just what it requires. A normal prepuce should cover about half the glans, and I will not quarrel with one that covers the whole glans, if there are no signs of irritation.
When I circumcise I try to leave just about enough to cover half the glans when the organ is relaxed. I have never employed the high operation, and have heard some complaints from patients who have undergone this style of operation, who suffer from the lack of protection to the sensitive corona. Whatever method is followed, the patient must be instructed as to future care and cleanliness.
In operating I use none of the many instruments specially designed for the purpose, having found them a bother and a hindrance to a perfect result. The tissue should be cut slantwise, parallel with the corona, and not stubbed off at right angles to the axis of the organ, as I have too often seen it done. The skin and mucous membrane should be trimmed so as to fit perfectly before the sutures are placed, and if difficulty is found in making the opening loose enough, the dorsal slit should be employed and corners trimmed off symmetrically.
I do not consider the work complete if the frenum is left too short. It should be of sufficient length to allow the prepuce to be fully retracted without bending the glans under. If found too short, a slight snip with the scissors will be all that is needed. These cases should be watched by the physician till healing is complete and all adhesions permanently destroyed.
I will not tax your patience with more cases nor details, thinking I have said enough to convince you that there is something in the subject – something that we as conscientious physicians cannot overlook, as it greatly influences not only the physical, but the moral development of those little ones who are placed in our charge. I hope that more interest may be aroused in this important subject, with the result that much unnecessary suffering may be prevented, and that our pauper and criminal classes, victims largely as they are of the results of sexual perversion and moral instability from physical causes, may be materially diminished as generations pass by, and I am confident that much may be done right along this line to hasten the millennium.
J.H. Beaty, “Some peripheral irritations common in young boys”, Journal of Orificial Surgery, Vol. 7, July 1898, p. 33-6
NOTEAlthough Beaty was associated with the extremist and often loopy Orificial Surgery Society, there is little difference between his understanding of phimosis and that of American physicians half a century later, nor between their methods of dealing with it. (See Alan Guttmacher, “Should the baby be circumcised”, 1941). Of equal interest is the mildness of Beatty’s operative technique, seeking to remove only a small portion of the foreskin and leaving enough to keep the glans half-covered. This is a far cry from the official “high and tight” style subsequently promoted by the US medical profession, in which the general aim was to remove as much tissue as humanly (some might say inhumanely) possible.